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'(5) If the Secretary of State is satisfied that a party to an agreement which constitutes, or is one of the agreements with together constitute, a pilot scheme is, or has become, a disqualified body (within the meaning of section (Provision of personal medical or personal dental services under a pilot scheme (disqualified bodies)), he must give directions to the authority concerned requiring them to bring the scheme to an end within twelve months in accordance with the directions.'.
Ms Jowell: The purpose of new clauses 2 and 3 is to close the door completely on the possibility of commercial involvements in pilot, schemes and we believe that they go substantially beyond the Government's amendments in providing safeguards against that.
The threat of the privatisation of primary care created by the Bill's provisions has been at the heart of our dispute with the Government over the Bill since its introduction. We remain convinced that this is what the Government actually want and what they actually intended, and we believe that it must be made impossible with all the drafting skill available.
Let me remind the House of the history of the climb-down that led the Government to table new clauses in Committee and to table further new clauses tonight, on Report.
The British Medical Association was strongly opposed to the Government's plans to allow what they describe as a third party in the doctor's consulting room. The BMA had no doubts that the Bill represented the commercialisation of the family doctor service, and it said in its press release of 24 January 1997:
Despite Government promises to ensure that the Bill does not pave the way for commercialisation of general practice, a range of companies insist that the Bill, as amended, does not alter their plans to become involved in
NHS primary care. All who want to follow events will no doubt eagerly read the current edition of Pulse, which has provided excellent coverage of this saga.
Let me give you, Madam Deputy Speaker, for example, the words of Sinclair Montrose Healthcare, the owner of a private GP clinic at London's Victoria station, which intends to make several pilot proposals for salaried GPs to work alongside privately employed GPs in its clinics.
That is why we have tabled new clauses that would keep the door to privatisation not two inches open but completely shut. Since the climbdown on commercialisation, the Secretary of State has tried to claim that concerns about commercialisation were misplaced. He is entirely disingenuous, but a series of statements by Ministers shows that privatisation was absolutely on the Government's agenda. It is also clear evidence that, if the Government were re-elected for a fifth term, they would push ahead with the full-scale privatisation of primary care. During the debate on the White Paper, in refusing to rule out companies employing GPs, the Secretary of State said:
The noble Baroness Cumberlege stated specifically in Committee in another place that companies would be able to bring forward proposals for pilot schemes. She said:
Mr. Simon Hughes:
My colleagues and I expressed concern about this matter on Second Reading. We acknowledged then that the Secretary of State had confirmed to the House that he intended to close the loophole, so we did not support the reasoned amendment tabled by the Labour party at that time.
I understand that the Government have some reservations about the new clauses. I am unhappy that they think that it is not worth trying to bolt down as tightly as possible the chance of private sector intervention. I am troubled also by the fact that, as far as I know, the Government have not yet given an undertaking to establish a register of general practitioners' interests and a register of the interests of all those in the health service, which, like the Register of Members' Interests, would be publicly available. We would then know absolutely whether any GP was acting as a front for someone else--such as the companies to which hon. Member for Dulwich (Ms Jowell) referred a moment ago--who was funding an operation for private commercial profit.
If we are limiting those who can approach the "NHS family" to conduct pilot schemes--as my colleagues and I believe absolutely and firmly that we should--it seems to me that the Government should accept the elaboration of that point in new clause 2.
The British Medical Association is much happier with the position as it now stands in light of amendment No. 11, which the Government undertook to bring forward. However, it remains concerned about one matter. It is worried that, under the new arrangements, there might be some risk to the partnerships that have been created already by GPs, especially for out-of-hours work.
When the Minister responds to new clause 2--which my colleagues and I will support--I ask him to address specifically how the changes in the Bill will impact on current arrangements, and particularly upon those who are working in commissioning or in other forms of partnerships for weekend, evening and night work. The BMA's concern should be addressed, and I would be grateful if the Minister could deal with it.
Mr. Ben Chapman (Wirral, South):
I am grateful, Madam Deputy Speaker, for this very early opportunity to address the House. I would like to begin by paying tribute to my predecessor, Barry Porter, whose sad and untimely death led to the Wirral, South by-election. He was a native Wirralian, and a popular and hard-working constituency Member of Parliament. As the Member for Bebington and Ellesmere Port and then for Wirral, South, he served the people of the Wirral for nearly 20 years. As I go around the constituency, I meet many of his friends and constituents who remember him with the greatest
I also take this opportunity to thank the right hon. Member for Wirral, West (Mr. Hunt), who so ably helped to handle constituency affairs while Wirral, South was without a Member of Parliament. Similar thanks are due to my hon. Friends the Members for Wallasey (Ms Eagle) and for Birkenhead (Mr. Field) for all their efforts during that period. Wirral Members of Parliament have traditionally worked together as a team when called upon to do so in order to serve the interests of the Wirral as a whole. That was evidenced this morning in the Adjournment debate, and it is evidenced by the presence of Wirral Members tonight. I intend to join that team, and to play a full part in it. Thanks are also due to my hon. Friend the Member for Ellesmere Port and Neston (Mr. Miller) for the considerable support that he has given me.
"It will undoubtedly make the privatisation of services that much easier. GPs must remain the patient's advocate, and any move that threatens to curtail GPs' freedom in the surgery is bad for patients."
The campaign against privatisation as created by the Bill has been led by the Labour party and the British Medical Association. However, only after the BMA threatened a hostile campaign in the run-up to the general election did the Government's resolve start to crack. After meetings with the BMA, they agreed to limit the employment of GPs to what they called the "NHS family".
"We can still run NHS services from our centres."
UniChem, which has also expressed interest in submitting a bid for a pilot, believes that the Bill, as amended, does not rule it out of the NHS as a primary care service provider. The company said:
"The door was reasonably wide open but it is now only open a couple of inches. We are waiting to see what the totality of the Bill is before we start drawing up a strategy."
Boots says that its plans to strike up a partnership arrangement with groups of GPs are not affected. BUPA is still "very interested" in developing its involvement in primary care, and the company said:
"We hope the door is not shut."
PPP Healthcare is the only company to have drafted a pilot proposal. Its plan to locate GP services at its private London hospitals--with all secondary referrals to the PPP hospital--is still "on the table".
"I am interested in a proper reward for those who deliver an efficient, high-quality service for the patient. Provided that I am satisfied that those tests are passed, I am willing to consider proposals made with the support of the professional staff concerned."--[Official Report, 15 October 1996; Vol. 282, c. 595.]
In an interview with Pulse magazine, he went on to confirm that the Government intended to open up NHS primary care to the primary sector. He said:
"If it is a difficult area and if a service cannot be provided using other routes, commercial enterprise may offer a solution. The main issue is whether it is an easily recognisable NHS service and it is better than the previous one provided."
That is what Ministers said about the private finance initiative.
"We are serious about tackling these difficulties and do not want to rule out any sensible opportunities, including a GP being employed by a commercial organisation . . . schemes put forward by commercial organisations will have to be endorsed by health authorities and then approved by the Secretary of State."--[Official Report, House of Lords, 17 December 1996; Vol. 576, c. 1403-4.]
12 Mar 1997 : Column 416
It is absolutely clear that in the world outside this place there is a very clear and established view that privatisation of primary care is still possible, despite the Government amendments to the Bill. Kingsley Manning of Newchurch Consultancy was reported in Pulse as saying:
We ask the House to support our new clauses this evening to make privatisation of primary care in the national health service not more difficult and more complicated, but absolutely impossible.
"I don't think it will remove the private sector. All it will do is to make the arrangements more complicated and more difficult".
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